Tips from Other Journals

Prescribing Smoking Cessation Medications at Well-Child Visit

Am Fam Physician. 2005 Nov 15;72(10):2106.

Secondhand smoke is associated with significant morbidity and mortality in children. Medication for smoking cessation doubles success rates, and offering such medication is a critical part of physicians’ efforts to treat tobacco dependence. Assessing parents during their child’s visit may be beneficial because many young adults, particularly in the under-served population, do not have health insurance. Little is known, however, about the attitudes of parents who smoke toward receiving medication from their child’s physician; nor is it known how often these medications are recommended and prescribed for parents. To clarify these issues, Winickoff and associates administered a telephone survey to a representative sample of the U.S. population.

The researchers used the Social Climate Survey of Tobacco Control, which examines beliefs, practices, and knowledge of tobacco control. Parents were asked if their pediatrician or family physician had asked about smoking and whether the physician recommended or helped with smoking cessation. Parents who smoked also were questioned about their willingness to quit.

A total of 3,990 persons were contacted, and 3,010 completed surveys. There were 1,027 parents overall, with 211 (21 percent) being smokers. Of those who smoked, one half said they would consider using a medication to aid cessation, and 126 (60 percent) thought it would be appropriate for the pediatrician or family physician to prescribe the medication. The percentage of those who approved of intervention was highest in those who were open to cessation.

Of 730 parents who had accompanied a child to a physician’s office in the past year, 143 were smokers. Rates of screening for tobacco use were low: 48.5 percent of the 730 parents reported being asked if anyone in the house smoked, and 25.5 percent reported being asked more specific questions such as whether smoking was allowed in the car. Of the smokers, 38 percent were advised to quit, 15 percent were recommended medication to facilitate quitting, and 7 percent were prescribed such medication.

Other studies have shown that physicians who provide care for children have low rates of providing effective interventions for parents who smoke. Reasons given by physicians for this include lack of time, lack of confidence in providing appropriate information, and concern that parents will not receive such efforts favorably. However, Winickoff and colleagues conclude that many parents who smoke would be interested in medications to help them quit smoking, and most of those parents (85 percent) would accept a prescription for such medication if offered by their child’s physician.